Provider Demographics
NPI:1649152703
Name:LEVITT, RINA
Entity type:Individual
Prefix:
First Name:RINA
Middle Name:
Last Name:LEVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 DOUGHTY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1314
Mailing Address - Country:US
Mailing Address - Phone:404-670-7362
Mailing Address - Fax:
Practice Address - Street 1:1227 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1314
Practice Address - Country:US
Practice Address - Phone:404-670-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86331042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered